Top three cancers in South Africa, trends and costs according to Discovery Health Medical Scheme

“In 2018, Discovery Health Medical Scheme (DHMS) paid out R3.5 billion for oncology-related claims,” explains Dr Ryan Noach, CEO of Discovery Health.

“Looking back, between 2011 and 2018, the total cost paid by the Scheme for oncology-related treatment has increased by a significant 135%. A combination of factors have contributed to this increase, including an increased prevalence of cancer, increased costs of cancer treatment and the introduction of new high-cost therapies. It’s therefore no surprise that the average cost per member in their first year of treatment is R173 065.”

2020 Oncology Claims Tracker highlights cancer’s impact

Cancer is the second leading cause of death globally, accounting for an estimated 9.6 million deaths, or one in six deaths in 2018[1]. Cancer also kills more people worldwide than HIV and AIDS, tuberculosis and malaria combined[2].

DHMS is South Africa’s largest, open medical scheme, with a current membership of 2.8 million lives. The 2020 DHMS Oncology Claims Tracker is the second edition of a special report highlighting key trends emanating from the member base. The report investigates the incidence (new cancer diagnoses) and prevalence (members actively claiming for treatment) of the top 10 cancers affecting members from 2011 to 2018.

Key findings from the 2020 DHMS Oncology Claims Tracker:

• From 2011 to 2018, there was a 24% increase in new cancer diagnoses and a 58% increase in DHMS members actively receiving treatment.
• In 2018, 8 731 members (0.31% of all DHMS members) were newly-diagnosed with cancer and 36 939 members (1.32% of all DHMS members) received cancer treatment through the Scheme oncology benefit.
• Between 2011 and 2018 there was an increase in new cancer diagnoses in adults across both genders (23%) and in children (18%).
• Among members older than 65 years, cancer prevalence has increased significantly since 2011. In 2018, 8.3% of all members between the ages of 65 and 80 were treated for cancer. This age group also experienced the highest incidence in 2018.
• Rates of new cancer diagnosis are 17% higher in men than women.
• Women aged 36 to 55 have higher rates of new cancer diagnoses than men in that age group.
• From age 56 on, men have a significantly higher rate of new cancer diagnoses than women.
• In 2018, the Scheme paid out R3.7 million in claims for a 45-year-old member with Leukaemia.
• Cancers of the central nervous system had the highest average cost during the first 12 months after diagnosis, at around R524 000 per member.
• Due to their high prevalence, claims related to breast and prostate cancer made up the bulk of what was paid out by the Scheme in 2018.

Preventative screening tests save lives

“The data reinforces the need for greater awareness efforts around cancer and life-saving, preventative screening tests,” says Dr Noach. “The fact that more members are being diagnosed with cancers that have spread to distant parts of the body, indicates that many people are still not undertaking regular screening tests for common cancers – such as breast cancer – and these are tests to which they have access through their Scheme benefits.”

Cancers in men, women and children

- Male cancers
In 2018, prostate cancer had the highest incidence for male Scheme members, followed by colorectal and lung cancer. The majority of men receiving active treatment for cancer have prostate cancer, which costs an average of R123 334 during the first 12 months after diagnosis. Since 2011 there has been a 30% increase in the number of male members newly diagnosed with prostate cancer each year and a 71% increase in members on active treatment for this cancer.

- Female cancers
The top two cancers by incidence for female members are consistent with global trends - with breast cancer being highest, followed by colorectal cancer.

“The number of DHMS members diagnosed with breast cancer each year has increased by 20% since 2011, with incidence increasingly significantly from age 40,” explains Dr Noach. The total cost paid by the Scheme for breast cancer-related treatment has also increased, but by a far larger margin - 107% - from 2011 to 2018. A total of R738 million was paid towards treatment of breast cancer in 2018 alone. Breast cancer costs R207 561, on average, to treat during the first 12 months after diagnosis. “The number of DHMS members receiving active treatment for breast cancer has increased significantly as a result of earlier diagnosis (linked to screening), improving survival rates and members remaining on treatment for a longer period of time,” adds Dr Noach.

Discovery has engaged extensively with pharmaceutical companies to source and secure affordable pricing and access to innovative treatment. A price decrease of 79% to R5,000 per unit was negotiated for a drug called Trastuzumab that is used to treat patients with a particularly aggressive strain of breast cancer.

- Colorectal cancer
The second-most prevalent cancer across adult men and women is colorectal cancer which costs an average of R313 739 to treat during the first 12 months after diagnosis. The top three biological drugs used to treat colorectal cancer have costs exceeding R100 000 per patient in 2018 and are often used in conjunction with other treatments.

Since 2011 there’s been a 31% increase in the number of members newly diagnosed with this form of cancer, and a 58% increase in members on active cancer treatment.

- Malignant melanoma
In 2018, the Scheme paid out R114 million towards melanoma-related treatments. “There’s been almost a doubling in members treated for malignant melanoma since 2011,” says Dr Noach. “This is a significantly higher increase than we have seen for breast, prostate and colon cancers.”

Cancers in children

The leading tumours affecting child DHMS members are leukaemia and brain tumours.

How does DHMS cancer data compare to South Africa and the world?

The age-standardised cancer incidence rate for DHMS is higher (239 per 100 000 lives) than amongst South Africans (202 cases per 100 000 lives) and globally (198 cases per 100 000 lives). “This is due to adverse selection in the open medical scheme environment. However the trend is likely also a reflection of the higher rates of cancer screening and diagnosis in the private healthcare sector compared to the South African and global public health sectors,” explains Dr Noach.

Supporting content:

1. Discovery Health’s Understanding Cancer podcast series

Access Discovery Health’s 10-part podcast series - ‘Understanding Cancer’ for key conversations with local oncology experts, cancer survivors, and other key individuals bringing new understanding to cancer’s complexities, informing and changing perspectives on this disease.

2. Discovery Health’s Oncology Hub

Explore cancer on Discovery Health’s Oncology Hub. Investigate healthy living to lower one’s cancer risk, cancer diagnosis and treatment, cancer’s impact on finances, support for caregivers, remarkable first-person narratives from cancer survivors, cancer relapse, palliative care and more.

(1) https://www.who.int/news-room/fact-sheets/detail/cancer
(2) http://ghdx.healthdata.org/gbd-results-tool

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